This 2023 focused update to the neonatal resuscitation guidelines is based on 4 systematic reviews recently completed under the direction of the International Liaison Committee on Resuscitation Neonatal Life Support Task Force. Systematic reviewers and content experts from this task force performed comprehensive reviews of the scientific literature on umbilical cord management in preterm, late preterm, and term newborn infants, and the optimal devices and interfaces used for administering positive-pressure ventilation during resuscitation of newborn infants. These recommendations provide new guidance on the use of intact umbilical cord milking, device selection for administering positive-pressure ventilation, and an additional primary interface for administering positive-pressure ventilation.

TOP 10 TAKE-HOME MESSAGES FOR NEONATAL RESUSCITATION

1. For term and late preterm newborn infants ≥34 weeks’ gestation who do not require resuscitation, delayed cord clamping (≥30 seconds) can be beneficial compared with early cord clamping (<30 seconds).
2. For term and late preterm newborn infants ≥34 weeks’ gestation who do not require resuscitation, intact cord milking is not known to be beneficial compared with delayed cord clamping (≥30 seconds).
3. For nonvigorous term and late preterm newborn infants (35–42 weeks’ gestation), intact cord milking may be reasonable compared with early cord clamping (<30 seconds).
4. For preterm newborn infants <34 weeks’ gestation who do not require resuscitation, delaying cord clamping (≥30 seconds) can be beneficial compared with early cord clamping (<30 seconds).
5. For preterm newborn infants between 28 and 34 weeks’ gestation who do not require resuscitation and in whom delayed cord clamping cannot be performed, intact cord milking may be reasonable.
6. For preterm newborn infants <28 weeks’ gestation, intact cord milking is not recommended.
7. Effective positive-pressure ventilation is the priority in newborn infants who need support after birth.
8. Using a T-piece resuscitator to deliver positive-pressure ventilation is preferred to the use of a self-inflating bag.
9. Because both T-piece resuscitators and flow-inflating bags require a compressed gas source to function, a self-inflating bag should be available as a backup in the event of compressed gas failure when using either of these devices.
10. Use of a supraglottic airway may be considered as the primary interface to administer positive- pressure ventilation instead of a face mask for newborn infants delivered at ≥34 0/7 weeks’ gestation.

SOURCE: Nicole K. Yamada, Edgardo Szyld, Marya L. Strand, Emer Finan, Jessica L. Illuzzi, Beena D. Kamath-Rayne, Vishal S. Kapadia, Susan Niermeyer, Georg M. Schmölzer, Amanda Williams, Gary M. Weiner, Myra H. Wyckoff, Henry C. Lee; on behalf of the American Heart Association and American Academy of Pediatrics, 2023 American Heart Association and American Academy of Pediatrics Focused Update on Neonatal Resuscitation: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Pediatrics 2023; 10.1542/peds.2023-065030